January 27, 2008

NST: LASER and cosmetic consultant Dr Kuladeva Ratnam advises his patients to get as many opinions as they can.
Dr Ratnam, who has a private practice in Bangsar, believes that while the Health Ministry is playing its role in weeding out bogus operators, patients owe it to themselves to do some checking.
“All surgical procedures come with risks, but it is important to choose a surgeon who is able to handle any complication in the event of an emergency,” he said.
Patients should demand a medical screening and allergy tests before going under the knife.
Said consultant occupational physician Dr Alice Prethima: “If you are scheduled for a nip and tuck and your surgeon has not asked for your medical records, this is a clear sign that he does not have your best interest at heart.”
Many are unaware of the allergies they have, especially to antibiotics. There is also a possibility of being “hyper” to foreign substances that may cause complications.
With silicone and other fillers easily available, people need to be extra cautious.
“I was shocked when a woman with a bag full of liquid walked into my clinic requesting to be injected with whatever she had brought with her,” Dr Alice said.
The substance turned out to be an industrial-type silicone, not for use on humans. It was claimed the liquid could enhance the breasts, hips or buttocks.
Dr Alice says that in most botched nip and tuck cases, the patients cannot identify the product that was used, making it all the more difficult to address the problem.
“Any good substance for cosmetic purposes should be sterile-packed and easily identifiable from the packaging.
“We are in an ‘information age’ where there is ample opportunity to do your own research and learn from other people’s experiences through websites and forums.”
Dr Alice warns against trying to mimic cosmetic procedures done on friends and family, as each person’s body and cells react differently.
“For someone who is overweight, I would advise against having liposuction. This procedure is for clearing ‘difficult’ fats and not for changing your overall body shape.
“In this instance, non-invasive procedures should be considered before taking such a big risk under the knife.”
When choosing the surgeon, she suggests that the patient insists on speaking to the attending doctor directly and not the receptionist or “consultant”.
“Most beauty consultants work by commission and are in competition to win over customers. There are reports of clients receiving contradictory advice from the same clinic.
“Any Tom, Dick and Harry can be trained, but it is in the face of complications when the truth is revealed.”
Lee Swee Seng, a mediator with Medical Defence Malaysia, says people should conduct research before any surgery.
“Do your research for whatever it is worth. Get second opinions if necessary. The Internet has proven to be a valuable avenue for information.
“It wouldn’t hurt to ask the doctor if you could get in touch with one of his clients to find out about the surgery.”

NST: SHE wanted big breasts but ended up without breasts.
Twenty-eight-year-old Anna Teoh (name changed to protect her identity) never failed to get flattering looks from men and women, yet she was dissatisfied. She felt bigger breasts would make her even more attractive and decided on breast augmentation.
She chose a doctor who came highly recommended by friends. The doctor, she was told, was from Taiwan and was in Kuala Lumpur on a holiday.
After the operation, Teoh started feeling sore. But she ignored it as the “surgeon” had warned her it was to be expected. After a few sleepless nights and days of pain, she noticed that her breasts were swollen and painful to the touch. Worse, pus was oozing at the area operated on.
She rushed to a hospital, where she underwent an emergency double mastectomy because of severe infection.
Teoh’s story is but one example of how the quest for beauty can go horribly wrong.
The MCA Public Service and Complaints Department has received more than 10 complaints of cosmetic surgeries going awry, according to its head Datuk Michael Chong.
“The problem is, some of these women did not go to a properly certified surgeon. They sought out ‘doctors’ or ‘surgeons’ through advertisements in the newspaper. In some cases, the ‘doctors’ had conspired with beauticians to be recommended to potential customers.
“When the patients realise their lives are in danger, they seek our help and we refer them for medical treatment, or for legal advice when the cases involved certified surgeons.”
He said these women would go for the surgery even when it was done in places such as hotel rooms, the backroom of a beauty salon or a house.
“No self-respecting doctor or surgeon would operate in hotel rooms. But these women choose to listen to their friends or to beauticians.”
Faced with this problem, the Health Ministry ruled last October that breast implants, liposuction, eyelid surgery, laser and light-based therapies and hair transplants should not be done by private general practitioners.
The restriction also extended to the use of Vitamin C, placental extract, stem cells and growth hormones by these “physicians”.
This, it appears, has had little effect, and the ministry is working on several proposals and drafts to amend the law.
In the meantime, it is business as usual for these “wellness” centres, beauty salons and “physicians”. One company even promises a one-stop shop for “your every need”.
One reason why some women prefer to have cosmetic surgery done by general practitioners or “physicians” at beauty parlours or hotel rooms is that it is cheaper.
According to lawyer P.S. Ranjan, a consultant in medical ethics, some patients were penny-wise and pound foolish. “They plan to save money when they go for such treatments, but basically they get what they pay for.
“They should go to someone with the proper qualifications and experience. Beauticians and traditional healers claim to do all sorts of things. These quacks and charlatans should be dealt with severely. Patients should be clear of who they are going to and have reasonable expectations.”
He said cosmetic surgery had therapeutic value as it could make people happy.
“In some cases, it can improve the patient’s quality of life. But, sometimes, what they really need is not a cosmetic surgeon but a good friend, counsellor, husband or boyfriend.”
Added Ranjan, “You should not live by others’ expectations. Symmetry is one of the things cosmetic aspects are concerned with, but all of us are asymmetrical. You can learn to live with perceived defects. After all, beauty is in the eyes of the beholder.”

Star: PENANG: Medical practitioners should invest in and adopt behavioural medicine to treat and curb illnesses, Health Ministry director-general Tan Sri Dr Ismail Merican said.
He said studies have proven that the application of behavioural medicine in treating patients resulted in positive outcomes.
“There is need to develop a multidiscipline medical care system. Behavioural medicine is the interdisciplinary field concerned with the psychosocial aspect of illnesses, health and healing. It promotes spiritual and mental well-being that are crucial to a person’s physical well being,” he said in his keynote address at the Conference of Behavioural Medicine.
“It is a holistic way to treat illnesses and the Health Ministry has established the Institution of Behavioural Research and introduced tradition and contemporary medicine, where behavioural medicine is the key element, in three hospitals.”
Datuk Dr Teng Hock Nan, who attended the conference on behalf of Chief Minister Tan Sri Dr Koh Tsu Koon, said the change of approach to behavioural medicine was appropriate.
“Life and work have become more competitive and stressful. It changes the kinds of illnesses we have to deal with,” he said, adding that holistic methods of treatment were needed to treat and curb such diseases.

January 19, 2008

NST: KUALA LUMPUR: People who do not brush their teeth properly may be putting themselves greater at risk of developing heart diseases.
The Health Ministry’s Oral Health Division director, Datin Dr Norain Abu Taib, said there was increasing evidence of the relationship between oral bacteria and life-threatening conditions, such as heart diseases, diabetes and respiratory ailments.
She added that periodontal diseases, in particular, were a life-threatening health risk.
Dr Norain said this when she launched an Oral-B “Plaque-Free Malaysia” campaign at the Giant hypermarket in Bandar Kinrara yesterday.
She said studies had also found that gum diseases could increase a person’s risk of developing diabetes.
“In Malaysia, the number of people with diabetes is increasing and it is important to make people aware of this link between oral infections and systemic diseases.”
The National Oral Health Survey of Adults found in 2000 that only 9.8 per cent of Malaysians had healthy gums.
“Clearly, the oral health messages and oral hygiene instructions received in our younger days need to be regularly reinforced to ensure continued compliance.”
The Oral-B campaign hoped to raise awareness on the importance of choosing the right toothbrush and brushing techniques.
Shoppers at Giant can take an Oral-B test to check their plaque.
“I wouldn’t have realised my problem with plaque because you can’t see it with your naked eye,” said Jay Chong, 28, after the test.
The campaign booth will be open until Thursday.

NST: KUALA LUMPUR: Smoking will be banned in more public places, among them the National Service training camps.
This squeeze on smokers is part of the government’s efforts to reduce their numbers. Appearing soon will be pictures depicting smoking hazards on cigarette packs.
The Health Ministry’s parliamentary secretary, Datuk Lee Kah Choon, said it was difficult to have a 100 per cent smoke-free environment.
Hence, by increasing the number of non-smoking areas, the government hopes smokers will kick the habit.
“Every year, we get about 100,000 NS trainees and we want to educate them about leading a healthy lifestyle.”
He declined to give a time-frame on the smoking ban in NS training camps, but said the authorities were working towards this.
Lee said his ministry was working with the Human Resource Ministry on plans to make all workplaces smoke-free. “It will take time to draw up the regulations, so I cannot give any target.
“Cigarette smoke deprives everyone of a clean and healthy environment. I hope the day will come when non-smokers can sue smokers for the damage caused by secondhand smoke.”
He added that the government was confident the public would eventually accept a smoke-free environment as a natural thing, just like non-smoking flights.
The government plans to reduce the number of smokers through a comprehensive programme, which includes education in schools, enforcement and stop-smoking assistance, such as the ministry’s information line (03-88834400) and the 105 “quit smoking” clinics nationwide.
The ministry is planning to have pictures showing the results of smoking on cigarette packs. Currently, cigarette packs carry a warning on the side panel.
Malaysia, which ratified the World Health Organisation’s Framework Convention on Tobacco Control (FCTC) in 2005, is required to display warning messages on at least 30 per cent of the cover of cigarette packets.
In Thailand and Singapore, which are also party to the FCTC, warning pictures such as unflattering teeth and a patient with damaged lungs are on the cigarette packets.
Lee said the government faced a battle with tobacco companies whenever they tried to reduce the price of cigarettes. “When the price is reduced, the young may be encouraged to pick up the habit.”

NST: KUALA LUMPUR: The number of cosmetic surgeries performed by individuals, including doctors, who are not trained in the field, is on the rise.
Dr Peter Wong, president of the Malaysian Association of Plastic, Aesthetic and Craniomaxillofacial Surgeons (MAPACS), said this was regrettable and it had resulted in many cases of botched cosmetic jobs.
“Many patients who are otherwise healthy have become miserable as a result. Even death has been reported,” he told the New Straits Times.
He said cosmetic surgery was a very difficult area that required many years of training and experience and it was best done by those who were specialised in the field.
“The public is advised to check on the credentials of the ‘doctor’ before allowing themselves to be put under the knife, rather than just relying on recommendation or hearsay from someone who may have personal or monetary interests,” said Dr Wong.
Commenting on the recent incident where a botched work on a 44-year old Datin has resulted in her fighting for her life, Dr Wong said people should be made aware of the dangers when they went to unqualified doctors.
He supported the efforts by the Health Ministry to check unethical practices by unqualified persons or doctors who had not been trained in the field of plastic and cosmetic surgery.
Dr Wong urged the public to report cases of botched jobs to the authorities so that action could be taken.

NST: KUALA LUMPUR: The wife of a member of parliament is fighting for her life following a botched cosmetic surgery.
The Health Ministry has picked up a doctor, in his 30s, for questioning.
The 44-year-old woman, a Datin, is now on a life-support machine at a private hospital and her condition is classified as very critical.
All she wanted was to look good. She had an eye bag surgery, a tummy tuck and liposuction. Now, she is unconscious and has been hooked to the life-support machine since last Friday.
“We are investigating the case and action will be taken against the doctor if he is found not qualified to do the surgery or had performed shoddy work,” Director-General of Health Tan Sri Dr Ismail Merican said yesterday.
“If we have strong evidence against him, then he will have to face the consequences. We will not compromise where patient safety is concerned,” he told the New Straits Times.
Ministry officials are also checking the status of the clinic and its operating licence to ascertain if it had flouted the Private Healthcare Facilities and Service Act and other regulations.
It is learnt that the Datin had gone to the clinic in Klang on Jan 9 to do an eye-bag surgery and subsequently decided to also get a tummy tuck and liposuction.
It is believed that an orthopaedic surgeon who did a three-week correspondence course in aesthetic medicine performed the almost eight-hour surgery.
The Datin, who encountered complications on the night of the surgery, was rushed to the National Heart Institute (IJN) the following day and later transferred to a private hospital upon request from her family.
A plastic surgeon, who declined to be named, said the woman could have suffered brain damage.
Dr Ismail said the ministry was coming out with guidelines on aesthetic medical practices.
Those who want to go into such practice must have evidence-based training and procedure.
“We do not allow doctors who have completed a three-week correspondence programme to do aesthetic medicine and surgery,” he said.
Asked if the surgeon involved in the Datin’s case would face the Malaysian Medical Council disciplinary board, Dr Ismail said this would depend on the outcome of the investigation and also if an official complaint was lodged against him.

NST: KUALA LUMPUR: A doctor who has operated his clinic for 10 years without registering it was fined RM120,000 by the Sessions Court yesterday.
Dr Basmullah Yusom earned the dubious reputation of being the first person in the country to be convicted under the Private Healthcare Facilities and Services Act 1998.
Dr Basmullah, 44, had been operating the Al-Hilal Medical Centre Sdn Bhd at No 55, Jalan 5/76B, Desa Pandan, off Jalan Kampung Pandan, since 1998.
The father of eight, who was charged on Dec 13 last year, had pleaded guilty to committing the offence at the premises at 10pm on July 11 last year.
Sentencing was fixed for yesterday. Under the act, he was liable to a maximum fine of RM500,000.
In mitigation, Dr Basmullah, who was unrepresented, pleaded for leniency, saying he did not register his clinic as he wanted to sell it and that he was not the only person running the clinic.
“I have financial problems and I still have to pay RM7,000 for the clinic and RM10,000 in personal loan,” he said.
“My wife is not working and I am the sole breadwinner for my family.”
Dr Basmullah said he had since moved to Putrajaya claiming it was cheaper to live there and that he had sold his car and was using a motorcycle.
“This financial burden is already a punishment itself for my mistake. I promise not to commit any offence again.”
DPP Norfiza Mohamed Noordin from the Health Ministry pressed for a deterrent sentence.
“Unlicensed clinics make it hard for the ministry to monitor them to ensure that they do not illegally sell drugs or conduct illegal abortions. This is to ensure public safety.
“Being busy and having financial problems are not excuses for not registering the clinic,” she said.
Judge S.M. Komathy Suppiah fined Dr Basmullah RM120,000 or three months’ jail.
At Press time, he had not paid the fine and was taken to the Kajang prison.

January 18, 2008

NST: KUALA LUMPUR: Besides direct organ transplants from brain-dead patients, selected hospitals have homograft banks where, for example, heart valves, corneas, certain tissues and bones are kept for use when the need arises.
Since 1992, the National Heart Institute (IJN) has had a homograft valve bank following requests from cardiac surgeons for quality-controlled, cryo-preserved heart valve homografts.
Homografts are tissues extracted from one species and implanted into a member of the same species.
In the case of cardiac homografts, the tissues are the aorta with the aortic valve and the anterior mitral valve leaflet; the main pulmonary artery, including the first few centimetres of the branch pulmonary arteries, and the pulmonary valve.
“The homografts are for patients with various cardiac diseases. In the majority of these cases, the outcome has been excellent. Before, all the homografts were flown in from tissue banks overseas,” said head of the IJN Department of Anaesthesiology and Intensive Care Unit, Datuk Dr Syed Abdul Aziz Syed Zin.
Dr Syed Abdul Aziz said the tissues were extracted from fresh cadavers and cryo-preserved for use in patients who need aortic valve replacements, or for the treatment of congenital heart diseases.
“IJN has successfully retrieved, prepared and implanted cardiac homografts in more than 110 patients.
“The homograft unit at IJN comprises cardiothoracic surgeons and perfusionists/medical technicians who are involved in retrieving, processing and cryo-preserving homograft tissues for storage.” he said, adding that children particularly, can benefit from homografts, where the need for small-sized prostheses and freedom from anti-coagulants are critical.

NST: KUALA LUMPUR: There were only 25 organ donors last year. That is why health authorities are planning to spend RM2 million this year to get more people to pledge their organs.
The National Transplant Resource Centre is planning to revamp its call centre to make it easier for donors to contact it, said its chief transplant co-ordinator, Datin Dr Lela Yasmin Mansor.
It is also recruiting additional staff.
There are plans to employ a director of promotions and a director of communications.
Dr Lela said the centre would also place advertisements on organ donation to create greater awareness of its importance.
“We will also be going to schools to educate children on organ donation.
“With the co-operation of the Education Ministry, we plan to hold competitions to gauge their perceptions and views on the donation of organs,” she told the New Straits Times.
Dr Lela said information kits on organ donation would be prepared for distribution to school-children and adults.
Last year, the authorities harvested three hearts, five livers, two lungs, eight heart valves, 16 corneas and five bones from 25 brain-dead patients.
In 2006, there were also 25 organ donors who donated 13 kidneys, a heart, six livers, a lung, 16 heart valves, 19 corneas, three skin implants and six bones.
Between 1976 and last year, 206 people donated 435 organs and tissues.
Kuala Lumpur Hospital Ne-phrology Department head Dr Ghazali Ahmad said there was a need for a dedicated full-time national co-ordinating organ transplant team for the programme to be successful. At present, those on the team are volunteers.
“Their weekends are spent going around holding talks, workshops and group sessions with community leaders and the public on organ donation.
“They even try to get the families of organ donors to speak on why they decided to donate the organs of their loved ones.”
He said when there were organ donors, these volunteers swung into action by going to the hospitals to harvest the organs and bringing them back.
Often, it was the same surgeons who performed the transplants.
“These are dedicated people who sacrifice being with their families to promote and do organ transplants to save lives,” said Dr Ghazali, adding that it was not easy for them as they had other jobs to do in hospitals.
The New Straits Times also learnt that the records of patients on the waiting list were not regularly updated, making it difficult to contact them.